Macroprolactinomas usually need long-term cabergoline therapy, often lifelong, as complete resolution of these tumors is rare. We present a vanishing pituitary macroprolactinoma which evolved into a complete empty sella following 2 years of cabergoline therapy. A 17-year-old girl with primary amenorrhea, chronic headache, and galactorrhea for 2 months was diagnosed to have pituitary macroprolactinoma (20 mm × 17 mm × 16 mm; prolactin 451 ng/ml). T2-weighted imaging revealed fluid level in adenoma suggestive of bleed in the tumor suggestive of pituitary apoplexy. Cabergoline was initiated at 0.5 mg/week and was uptitrated to 3 mg/week over 6 months to ensure prolactin was suppressed. Magnetic resonance imaging pituitary after 2 years of cabergoline therapy revealed empty sella with pituitary stalk traced till the floor of sella turcica, without any evidence of adenoma. Hormone evaluation revealed low total T4 levels (5.1 mcg/dl); low thyroid-stimulating hormone (0.9 mIU/L); normal morning cortisol (18.1 mcg/dl); and normal prolactin (4 ng/ml), leading to the diagnosis of secondary hypothyroidism. Cabergoline dose was tapered gradually. Levothyroxine replacement was started at 50 mcg/day. Pituitary apoplexy and associated infarction 2 years back lead to ischemic necrosis in adenoma, leading to its spontaneous resolution in our patient. The adenoma had damaged adjacent normal pituitary cells due to limited space in sella, resulting in empty sella. Pituitary apoplexy is nature's way of curing pituitary adenoma. Complete disappearance of adenoma and the resulting empty sella syndrome are the novelty of this report.


It is shown that primary screening of drugs against the pathogens of hemorrhagic fever with renal syndrome (HFV) may be performed, by using two approaches in estimating the suppression of plague formation and that of viral reproduction in the cultured cells. It is expedient to make a primary screening of interferon and its inductors to estimate the suppression of viral reproduction in the cultured Vero E6, PSEV, and CL-17 cells, the infection multiplicity should be hundredth parts of BOE/cell. Among the test agents, there are virazole and realdiron that are the most active drugs against Hantaan virus, 76-118 strain, which virually completely suppress the reproduction of the study causative agent, when used even at concentrations of 1-5 microg/ml and 100 U/ml, respectively.


This dissertation is an exploration of the ways in which certain forms of interactive art may elicit experiences of co-evolution within an increasingly technologized environment. These "emer-gent arts," the author argues, facilitate or amplify a construction of a reality that is (inter)active, dynamic, heterogeneous and always already emerging, constituted by dynamic relationships rather than objective facts. This ontological vision resonates with constructivist and phenomenological theories of reality as well as neocybernetic notions of "observer-participants" and "enac-tive perception." The term "co-evolution"—often taken to allude to Darwinian biological processes of interaction between two or more species—is recast to refer here to processes of emergence, self-organization and autopoiesis. New approaches to understanding and studying technologically based artworks are proffered that attend to how these artworks are contributing to a new range of experiences that more adeptly attune us to our techno-ecological context—experiences that the author refers to as "symbiogenic." The research combines both theory and practice, combining artworks, scholarly writing and subjective accounts in order to build the foundations of a theoretical framework for identifying and analyzing these experiences. By examining these artworks and experiences via the interlocking frames of cybernetics, phenomenological philosophy, posthumanism and interactive/new media art, this dissertation articulates the movement toward a framework that provides insights into how interactive art may engender shifts in perceptual experience, enabling us to view ourselves as connected to and implicated in an infinitely complex world.


Bacillus subtilis strain FP-133, isolated from a fermented fish paste, synthesized two novel halotolerant extracellular proteases (expro-I and expro-II), showing activity and stability at concentrations of 0–20% (w/v) NaCl. Each protease was purified to homogeneity and characterized. The purified expro-I was a non-alkaline serine protease with an optimum pH of 7.5, although most serine proteases from Bacillus strains act at the alkaline side. The molecular mass of expro-I was 29 kDa. The purified expro-II was a metalloprotease with a molecular mass of 34 kDa. It was activated by Fe2+, which has never been reported as a bacterial protease activator. At a concentration of 7.5% (w/v) NaCl, both proteases preferred animal proteins to vegetable proteins as natural substrates. In addition, under saline conditions, expro-I and II showed high catalytic activity toward gelatin and casein respectively.


The Capital Asset Pricing Model (CAPM) is widely used in corporate finance to assess expected returns of securities and return on equity, and beta, a measure of systematic risk, is a component of the CAPM equation. Previous studies appear not to have addressed whether beta as a stand-alone metric allows individual investors to effectively assess returns relative to the market, and this study aims to address this. Exchange-traded funds (ETFs) reflecting a range of expected volatilities relative to the S&P 500 index were selected. Betas of XLK (Technology sector), XLE (Energy sector), XLU (Utilities sector), and XLY (Consumer Staples sector) were estimated by regressing their weekly returns over five years against those of the S&P 500 index. Three five-year periods were used (ending in 2005, 2010, and 2015). The betas largely conformed to anticipated values with the exception of that of XLY which was surprisingly greater than the market beta. Estimated and observed betas were compared using a two-tailed paired T-test and no difference was found, suggesting that estimated beta is statistically a good proxy for actual beta. In practical terms though, there were relatatively large variances in several instances between estimated and observed betas, and this could be a concern for investors. Returns using estimated beta and actual returns were also compared over one, two, three, four, and five years with regard to the three five-year periods. Significant variation was observed for expected minus observed returns both in sign and magnitude. A two-tailed paired T-test suggested there was a difference between returns using estimated beta and actual ones over the three five-year periods for all funds except XLE. The observations suggest betas are volatile and individual investors should incorporate additional metrics to forecast returns relative to the market.


With the Oil and Gas drilling moving to deeper and deeper waters, offshore blow-out control and recovery methods imply bigger challenges. In this scenario of technology complexity and of ever increasing focus on safety and environmental issues, with the aim to minimize operative risks, a new dual ROV assisted well killing system for deepwater blow-out recovery was developed and patented. This system extends the range of actions to be used in case of a deepwater subsea blow-out during drilling operations. The system stands as a quick-response tool devoted to assist and enhance the probabilities of success of a vertical intervention from a Dynamic Positioning Rig on a deepwater well in blow-out, when the premises for such an intervention exist or could be created. The system is designed to use two ROVs to assist the re-entry of a killing string inside the flowing well to perform the vertical intervention. The system is also equipped with acoustic sensors for a full instrumental localization of the blow-out source in case of impaired visibility. When successful, this intervention minimizes hydrocarbons losses, environmental impact, operational costs and exposure to liability claims. The system and its sub-systems have been fully designed, developed and tested. System marinization has been addressed to, involving drilling rig operators and a third party certification body to review system interfaces, handling procedures and risk assessment for a safe use on board. This paper provides a description of the proposed intervention system, along with details on the achievements and lessons learnt in the development and testing phases.


The three-dimensional transport element method is extended to solve the conservation equations for reacting flow. The numerical scheme belongs to an adaptive, Lagrangian class of field methods in which the computational effort is concentrated in zones of finite vorticity and chemical reaction. The method is based on the accurate discretization of the vorticity and species concentrations among a number of spherically-synunetric transport elements, and the advection of these elements along particle trajectories. We use the low Mach number approximation of comhustion in an open domain, and restrict our attention to the case of diffusion flames at low values of heat release. A singlestep, second-order, infinite-rate kinetics chemical reaction model is employed. to study the influence of flow induced by the primary and secondary instabilities on the reaction zone and product distribution in a temporal shear layer. Results are obtained in the high Peclet number regime for a wide range of Damkohler nwnbers. Changes in the reaction field can he related to either the entrainment or the strain field associated with the saturation of the instabilities. With increasing Damkohler number, the structure of the reaction region changes from a distributed zone embedded within spanwise and stremise vortices, to a thin sheet surrounding their cores. However, the product concentration always exhibits strong similarity to the vorticity distribution, realizing its highest values in zones of high vorticity and falling rapidly in regions where the magnitude of the vorticity is small. Variation of the Peclet number yields minor changes in the shape of the product distribution and in the structure of the reaction zone, but strongly affects the product formation rates. 'The scheme is applied


Recent development in telecommunication and information technologies came up with several technology options for telemedicine applications in hospitals and for medics for quality healthcare to patients. The research trends therefore need to be addressed for the proper deployment of technologies in a clinical setting or in a telemedicine environment with the adaptive compromise of technology and suitability. In this chapter, along with a description of the research trends and system design issues concerned with telemedicine, a mobile telemedicine system architecture and design have been proposed. Other current telemedicine technology options and prospects and challenges of future research in this emerging area are also described to indicate the possible future research challenges. Research in telemedicine is a future to provide improved and quality access to the healthcare professionals and patients. Therefore, developing telemedicine systems with state-of-the-art technologies is of paramount importance and hence, this chapter would link up an important step in system analysis and design perspective to this evolving research arena.


The label 'extreme' has traditionally been used to describe out-of-the-ordinary and quasi-deviant leisure subcultures which aim at an escape from commercialized and over-rationalized modernity or for occupations involving high risk, exposure to 'dirty work' and a threat to life (such as military, healthcare or policing). In recent years, however, the notion of 'extreme' is starting to define more 'normal' and mainstream realms of work and organization. Even in occupations not known for intense, dirty or risky work tasks, there is a growing sense in which 'normal' workplaces are becoming 'extreme', especially in relation to work intensity, long-hours cultures and the normalizing of extreme work behaviours and cultures. This article explores extreme work via a broader discussion of related notions of 'edgework' and 'extreme jobs' and suggests two main reasons why extremity is moving into everyday organizational domains; the first relates to the acceleration and intensification of work conditions and the second to the hypermediation of, and increased appetite for, extreme storytelling. Definitions of extreme and normal remain socially constructed and widely contested, but as social and organizational realities take on ever more extreme features, we argue that theoretical and scholarly engagement with the extreme is both relevant and timely.


Inline printing and coating methods have been demonstrated to enable a high technical yield of fully roll-to-roll processed polymer tandem solar cell modules. We demonstrate generality by employing different material sets and also describe how the ink systems must be carefully co-developed in order to reach the ambitious objective of a fully printed and coated 14-layer flexible tandem solar cell stack. The roll-to-roll methodologies involved are flexographic printing, rotary screen printing, slot-die coating, X-ray scattering, electrical testing and UV-lamination. Their combination enables the manufacture of completely functional devices in exceptionally high yields. Critical to the ink and process development is a carefully chosen technology transfer to industry method where first a roll coater is employed enabling contactless stack build up, followed by a small roll-to-roll coater fitted to an X-ray machine enabling in situ studies of wet ink deposition and drying mechanisms, ultimately elucidating how a robust inline processed recombination layer is key to a high technical yield. Finally, the transfer to full roll-to-roll processing is demonstrated.


This paper is concerned with the investigation of the effect of magnesium to sulfur ratio on the graphite morphology and estimation of the ranges of this ratio use to produce graphite cast iron at different section sections. The main factors affecting shape of graphite cast iron are the metallurgical structures and the section thicknesses. Cast iron of different shapes of graphite particles directly affect its thermo-mechanical properties. The nodular shape of these graphite particles such as in ductile cast iron improve its mechanical properties, on the other hand, when the shape of these graphite particles become elongated such as in flake graphite cast iron results in improving its thermal conductivity. In between, the worm-like shape of these graphite particles such as in compacted graphite cast iron, make this type of cast iron to have thermo-mechanical properties in between those of ductile and flake graphite cast iron. The different types of ductile , compacted and flake graphite cast iron were produced by means of plunger method at different section thicknesses and the effect of Mg/S ratio on these types of graphite particles was investigated and its range was established.


Consider an agent with time-separable constant absolute risk aversion preferences who faces an exogenous income process and has access to a riskless saving technology with a constant interest rate. That agent's indirect utility over income streams is a form of Epstein‒Zin (1989) preferences. Epstein‒Zin preferences have been widely studied in the recent literature because of their implications for the pricing of shocks to expectations of future economic conditions. Identical predictions are naturally and generally obtained also under purely time-separable preferences. The paper's results also point toward a very broad class of analytically solvable models.


Purpose
The purpose of this paper is to understand caregivers' discursive constructions and responses to their unwanted (family and social) role as resulting in exchanges on social media. Online group platforms are understood as particularly suitable for the expression of intimate feelings among adults, for meeting and exhibiting stigma issues, and for the circulation of information and support (Suler, 2004; McCormack, 2010; Pounds et al., 2018).

Design/methodology/approach
This paper draws from digital Conversation Analysis (Giles et al., 2015), and considers data after combining quantitative (corpus analysis) and qualitative methods, from a critical discourse analysis perspective. The Stereotype Content Model (SCM; Fiske et al., 2002) is used together with collocation analysis to understand categorisations, which ultimately result in a defence strategy (Assimakopoulos et al., 2017) to negotiate the Self and the Others (Tannen, 1992).

Findings
Considering that the digital environment allows a discursive negotiation of identities, data suggest that these interactions are expressions of membership construction, group solidarity and empowerment, that normalise and legitimise emotions with the ultimate goal of (self-)acceptance.

Originality/value
This study provides a basis for further research on caregivers' self-positioning in power-relations with others.


Due to the intense concentration of heat in the welding process, residual stresses are produced in the specimen. One of the most effective ways to relief welding stress is Post Welding Heat Treatment (PWHT). In this paper, finite element method is employed to model and analyze PWHT for two pass butt-welded SUS304 stainless steel pipe. In this simulation, firstly, the welding process has been modeled. Then the stress distribution of the specimen has been transferred to a second analysis for stress relaxation modeling. Norton law is used to investigate creep in stress relief process. Experimental tests are also carried out to verify the effectiveness of the proposed numerical models. The hole drilling method is used to measure the stress distribution in the specimen. The residual stress distribution data before and after PWHT are compared to investigate the effect of heat treatment on residual stress. Based on the modeling and experimental results, the tensile and compressive stresses distributions have been reduced. They are in a reasonable agreement with each other and prove the capability of the proposed modeling technique to simulate PWHT.


This thesis presents a framework for inter-agent communication, represented and partially implemented with default reasoning. I focus on the limited goal of determining the meaning for a Hearer-agent of an utterance u> by a Speaker-agent, in terms of the beliefs of the interlocutors. This meaning is generally more than just the explicit propositional contents of u, and more than just the Speaker's goal to convey her belief that u>. One way of determining this meaning is to let the Hearer take stock of the implicit components of the Speaker's utterances. Among the implicit components of the meaning of u, I show in particular how to derive certain of its presuppositions with a set of default schemata using a framework for default reasoning. More information can be extracted from the communications channel between interlocutors by adopting a normative model of inter-agent communication, and using this model to explain or 'make sense' of the Speaker's utterances. I construct such a model expressed in terms of a set of default principles of communication using the same framework for default reasoning. The task of deriving the meaning of an utterance is similar to the job required of a user-interface, where the user is the Speaker-agent, and the interface itself is the Hearer-agent. The goal of a user-interface as Hearer is to make maximal use of the data moving along the communications channel between user and application. The result is an integrated theory of normative, inter-agent communications expressed within an ontologically and logically minimal framework. This work demonstrates the development and application of a methodology for the use of default reasoning. The implementation of the theory is also presented, along with a discussion of its applicability to practical user-interfacing. A view emerges of user-modelling as a component of a user-interface.


This paper studies the dynamic web service selection problem in a failure-prone environment, which aims to determine a subset of Web services to be invoked at run-time so as to successfully orchestrate a composite web service. We observe that both the composite and constituent web services often constrain the sequences of invoking their operations and therefore propose to use finite state machine to model the permitted invocation sequences of Web service operations. We assign each state of execution an aggregated reliability to measure the probability that the given state will lead to successful execution in the context where each web service may fail with some probability. We show that the computation of aggregated reliabilities is equivalent to eigenvector computation and adopt the power method to efficiently derive aggregated reliabilities. In orchestrating a composite Web service, we propose two strategies to select Web services that are likely to successfully complete the execution of a given sequence of operations. A prototype that implements the proposed approach using BPEL for specifying the invocation order of a web service is developed and served as a testbed for comparing our proposed strategies and other baseline Web service selection strategies.


The Sun has remained a difficult source to image for radio telescopes, especially at the low radio frequencies. Its morphologically complex emission features span a large range of angular scales and the emission mechanisms involved, span a wide range in brightness temperatures. In addition, time and frequency synthesis, the key tool used by most radio interferometers to build up information about the source being imaged is not effective for solar imaging, because many of the features of interest are short lived and change dramatically over small fractional bandwidths. Building on the advances in radio frequency technology, digital signal processing and computing, the kind of instruments needed to simultaneously capture the evolution of solar emission in time, frequency, morphology and polarization over a large spectral span with the requisite imaging fidelity, and time and frequency resolution have only recently begun to appear. Of this class of instruments, the Murchison Widefield Array (MWA) is best suited for solar observations. The MWA has now entered a routine observing phase and here we present some early examples from MWA observations.


We derive upper bounds for the index of cyclicity of a matrix as a function of the size of the matrix. This result can be used in the characterization of the ultimate behavior of the sequence of consecutive powers of a matrix in the max-plus algebra, which has maximum and addition as its basic operations. If the matrix is irreducible then it is well known that the ultimate behavior is cyclic. For reducible matrices the behavior is more complex, but it is also cyclic in nature. The length of the cycles corresponds to the index of cyclicity of the given matrix.


Peter McKenna is assistant professor in the Department of Political Studies at the University of Prince Edward Island in Charlottetown and the co-author of Canada-Cuba Relations: The Other Good Neighbor Policy.A GOOD DEAL HAS CHANGED IN THE WORLD since the horrific terror attacks of 11 September. Indeed, the Taliban have been vanquished in Afghanistan, Saddam Hussein's brutal regime in Iraq has been toppled, and a fledgling "road map" to peace in the Middle East has been championed by the Bush White House.But even with this sea of change internationally, precious little has been altered with respect to Cuba's place in the western hemisphere. If anything, the post-9/11 milieu has spawned a hardening of views towards Fidel Castro's Cuba--in part because of Havana's crackdown on prominent dissidents in early April 2003.(1) Others have suggested that Castro's move to imprison and silence his critics was, in part, a function of intensified US pressures internally, especially in light of the role of James Cason, the head of the US Interest Section in Havana, and concerns abut the Bush administration's external doctrine of pre-emptive military action and "regime change."(2)Accordingly, debate over the prickly question of Cuba is sure to produce a plurality of viewpoints, emotions and disagreements. The policy positions of the US, Mexico, the EU and Canada--all key foreign powers from Cuba's perspective--reflect that plurality of viewpoints. And yet when one compares their policy perspectives towards Cuba, one discovers more similarities than differences between them.Granted, the United States is the oddity amongst the group--and rightly so given its geographical proximity, historical linkages and ideologically laced policy. But even though some rather obvious differences do exist, it is the similarities within the group that are most striking. Indeed, all four share the same core policy objectives vis-a-vis Cuba, and each has remained remarkably consistent in trying to secure them since the early 1960s--while clearly parting company over the precise means for achieving those goals.The objectives of this paper are threefold. First, to outline the policy approaches of the four governments since the early 1990s, emphasizing recent changes or developments. Secondly, to will discuss the various similarities and differences in policy approaches. And finally, to proffer some observations on what the future policy directions of the various governments are likely to be, and whether they can derive some policy lessons or political learning from each other.POLICY APPROACHES TOWARD CUBA: THE US VERSIONGiven the long-standing role and dominance of the United States in the Americas, and its storied history with Cuba, it makes sense to begin here. Since the early months of Fidel Castro's rise to power in 1959, the United States has viewed Cuba in a noticeably negative light, hermetically sealed within a seemingly frozen Cold War dynamic. Cuba was initially regarded by Washington as a serious security threat and a possible Soviet beach-head in the Americas, an unrepentant exporter of revolutionary upheaval, and an unacceptable regional "model," and thus the confrontational tone of the relationship was cast in stone very early. Neither side was prepared--for a host of international, domestic and individual reasons--to bend or to compromise to the other's overtures and pressures. Thus, for over forty years the US-Cuba relationship has remained frozen in time--poisoned by mutual distrust and visceral animus.Successive US administrations--all professing to one day set foot in a free and democratic Cuba--have maintained a consistent approach toward Havana: a policy based largely on confrontation and isolation. At one time or another, each administration has sought to facilitate the removal of Fidel Castro and to bring an abrupt halt to the Cuban revolution, to institute liberal democratic and market reforms on the island, and to establish a US-friendly government in Cuba. …


Chest radiography (CXR) and abdominal ultrasound (US) are two widely used diagnostic imaging techniques in Western societies. General practitioners (GPs) in The Netherlands annually request approximately 500,000 CXRs and 200,000 abdominal US, and therefore clearly place a burden on health care. Besides, diagnostic investigations may lead to incidental findings, or to additional unnecessary diagnostic procedures. Little is known on the diagnostic yield of CXR and abdominal US in patients referred by GPs. The objective of this thesis was to determine the clinical effectiveness of CXR and upper abdominal US in general practice. Large part of this thesis was based on a prospective cohort study conducted from April 2003 to December 2004, with the participation of 78 GPs in the catchment area of three general hospitals located in The Netherlands. All patients of 18 years and older who were referred for CXR or upper abdominal US by their GP were included in the study, resulting in a study population of 1300 patients (870 CXRs and 430 upper abdominal US). All GPs were asked to fill in a standardized form before and after the radiological investigation, including information on the suspected diagnosis, and proposed patient management. Clinically relevant abnormalities were found in 24% of the CXRs. Anticipated patient management changed in 60% of the patients following CXR. The main changes included fewer referrals to a medical specialist (from 26% to 12%), a reduction in initiation or change in therapy (from 24% to 15%), and more frequent reassurance (from 25% to 46%). A change in patient management occurred more frequently in patients with complaints of cough, exhibited abnormalities during physical examination, or a suspected diagnosis of pneumonia. Pneumonia was diagnosed by GPs in 35 of 192 primary care patients suspected of pneumonia (18%), of whom 27 patients (14%) had a positive CXR, and 8 patients (4%) a negative CXR, however with an assumed high probability of pneumonia by the GP. CXR clearly influenced the diagnosis of pneumonia by the GP in 53% of the patients: CXR ruled out pneumonia in 47%, and the probability of pneumonia substantially increased in 6% of the patients. Anticipated patient management changed after CXR in 69% of the patients. Clinically relevant abnormalities were found in 29% of the abdominal US, mainly cholelithiasis. Anticipated patient management changed in 64% of the patients following abdominal US. Abdominal US substantially reduced the number of intended referrals to a medical specialist (from 45% to 30%), and more patients could be reassured by their GP (from 15% to 43%). A change in anticipated patient management occurred more frequently in patients with a prior cholecystectomy. Almost 50% of the patients were referred for abdominal US because of a clinical suspicion of gallstones. Cholelithiasis was detected with US in 29% of the patients with, and 11% without a clinical suspicion of gallstones. Marked differences were found in signs and symptoms of patients suspected of gallstones with and without cholelithiasis detected on abdominal US, and in patients with expected and unexpected gallstones.


As U.S. immigration policy and its human impact gain popular salience, some have questioned whether immigration courts—often the first-line adjudicators of deportation—are "courts" at all in the American adversarial legal tradition. This Article aims to answer this question through a focus on the role of the immigration judge (IJ). Informed by in-depth interviews with twelve former IJs and three former supervisory officials, I argue that immigration courts present with superficial hallmarks of adversarial courts, but increasingly exhibit core features of a tightly hierarchical bureaucracy. Although not all features of an immigration bureaucracy are inherently undesirable, masking a bureaucracy with judicial trappings results in a deceptive façade of process that likely limits scrutiny from federal courts and calms public discontent with harsh immigration laws. In light of this phenomenon, enhancing IJ independence through the creation of an Article I immigration court would solve some problems with immigration adjudication but risk papering over others. Instead, achieving a fair system will require both procedural and substantive reforms.


ABSTRACT In animals that experience interactions with conspecifics while young, social interactions appear to be a necessary prerequisite for typical behaviour. Eusocial insects have large colonies where individuals experience a large number of social interactions with nest mates during all life stages, making them excellent candidates for understanding the effects of social isolation on brain development and behaviour. Here, we used the honey bee Apis mellifera to study the effect of social isolation and group size on reward perception and discrimination learning and memory. We confined day-old adult workers into three different size groups (1, 8 or 32 bees) for 6 days during a critical period associated with adult behavioural maturation. We quantified their sucrose responsiveness, their ability to use and remember olfactory cues to discriminate between sucrose and salt (i.e. discrimination learning), and four biogenic amines in the brain. We found that the smaller the group size, the more responsive a worker was to the sucrose reward. Honey bees raised in groups of 32 performed the best in the learning trials and had the highest levels of dopamine. We found no effect of group size on memory. The observed group size effect on learning but not memory supports the hypothesis that social interactions modulate learning through the dopaminergic system. Summary: Honey bee workers raised in small social groups have higher sucrose responsiveness, worse discrimination performance and lower levels of dopamine than bees raised with more con-specifics.


Within the landscape of the Central Appalachian coalfields, entire areas exist under the threat of mountaintop removal coal mining and depopulation. This article offers, for the first time, a description of the contemporary landscape of the southern West Virginia coalfields (SWVC) from a cultural landscape perspective. Through a directed qualitative content analysis (CA) of Ann Pancake's novel Strange as This Weather Has Been (2007), the study examines the novel's depiction of the landscape as a space of endangered, low-forested mountains and narrow valleys, heavily altered by industrial activities and made vulnerable to human-made disasters, whose inhabitants grieve its disappearance and the vanishing of the mountain culture. This portrayal of the SWVC landscape is validated by scientific literature in various disciplines. The investigation provides a new perspective on how a CA of a work of fiction—when coupled with "'holistic' models of landscape" interpretation (Stephenson, 2008, 129)—can be used to reveal aspects of a landscape that are often disregarded, such as its cultural values. It also shows that CA can be a reliable source of information in landscape studies and be used as a valuable alternative when primary sources are unavailable. The study presents a unique representation of the SWVC region that underlines the often overlooked tangible and intangible qualities of its landscapes.


This paper discusses a method I used to conduct a study of hygge, a Danish concept that is usually translated as "cosiness." I wanted to learn more about hygge and how it related to technology in the home. The method I used builds on my experience with spatial ethnography, on Bruno Latour's theory of representation, and on the work of visual anthropologist Sarah Pink. I asked participants to use a video or still camera to help me document their home. With participant and researcher both behind the lens of a camera, I saw a significant remapping of the power relationship between researcher and participant; we were able to focus together on the material home as the object of the research. In addition to reducing the time needed to build rapport, this method offers a way to analyze cultural practices such as hygge that are not entirely visible in the material world.


Heart transplantation is the last careful alternative for newborn children and small kids with inherent cardiovascular breakdown after bombed ordinary fix or palliative methods. We plan to introduce our outcomes in a review and graphic investigation. Techniques: Eighteen heart transplantations on youngsters (nine females and nine guys) were performed from 1988 to 2015. The scope old enough was between 0 days and three years. Signs for a transplantation were hypoplastic left heart disorder (n=14), non-compaction-condition (n=2), Bland-White-Garland-condition (n=1) and rendering of the incredible corridors (n=1). Fourteen youngsters (78%) had a past cardiovascular medical procedure. Four patients (22%) required mechanical circulatory help for spanning: ECMO (n=2; 11%), or LVAD and ECMO (n=2; 11%). Fifteen (83%) experienced a biatrial technique, three (17%) a bicaval one. Results: The middle holding up time in the wake of posting was 68 days (min: 0 days, max: 386 days, standard deviation (SD): 102.8 days). The general endurance was 61%, 13 youngsters (72%) endure the main year. Two patients (11%) had transplantation. The middle time patients spent at emergency unit 17 days (min: 1 day; max: 121 days). They were respirated for seven days (min: 1 day; max: 91 days). Perioperative variables we broke down were: the middle myocardial ischemia time was 236 minutes. The middle aortic cinch time was 95 minutes; the middle time of circulatory capture was an hour. Three kids (17%) got a pericardial emission. Two  patients (11%) endured each: dying, cardiovascular arrhythmias, diaphragmatic paresis and cerebral difficulties. Five (28%) got a lymphoproliferative sickness. Seven kids (39%) got a coronary unite vasculopathy. Two (11%) required interventional treatment. Three (17%) got a cardiovascular pace producer. As per our information, six kids had a dismissal which called for treatment. End:


The hypothesis was put forward that, along with the regulation of mass center projection, the system of upright posture control stabilizes the deviation of pressure center from the position of the mass center projection. The regularities in the behavior of the trajectories of pressure center and mass center projection were analysed. Experimental evidence was obtained supporting the validity of the hypothesis. The structure of the control system that corresponds to the new understanding of the variables being regulated during the maintenance of vertical posture was considered.


Despite wide ranging advances in neurological therapeutics for many neurological conditions, there are frustratingly few interventions that can reverse a neurological deficit or prevent deterioration. Patients are faced with the consequences— some of which we can help. One such is loss of function at the ankle, for example, from foot drop, with its associated impact on walking. Sometimes this is temporary, for example, after a stroke, but in others is permanent. Ankle orthoses can significantly improve function but the choice of orthosis depends on several factors, including whether the problem affects the swing phase or the stance phase of walking. Stephen Kirker discusses the range of orthoses available, from simple to highly sophisticated, illustrated with 15 examples (page 311). This practical intervention—barely a footnote in most neurological textbooks—will often substantially help patients. When a patient has had a seizure, or presents with epilepsy, they are prevented from driving. For many people, their loss of driving privileges can seem of greater consequence than their seizure, especially if they were barely aware of the seizure itself, for example, if it occurred during sleep. Jeremy Rees et al (page 268) explore the UK's driving regulations for medical conditions and the reasoning behind the rules and how they differ internationally. In a linked editorial, Tony Marson discusses the challenges of developing and implementing these rules, balancing the rights of a driver against the risks to the public, the heterogeneity of drivers and their diagnoses, and the uncertainties and limitations in the evidence, particularly for neurodegenerative disorders (page 266). Classical infratentorial superficial siderosis is usually the late consequence of a previous neurological insult, either neurosurgical or traumatic, often from many years before. Natallia Kharytaniuk et al discuss the presentation of this condition (page 274)—usually with deafness and progressive imbalance but often myelopathy or polyradiculopathy. They describe its diagnosis using particular MRI sequences and explore the as yet limited treatment options from the perspective of a specialist unit. When there is limited evidence and uncertainty about management, we can often be helped by advice from a specialist unit. The understanding of CSF biomarkers for dementia is advancing quickly, though their role in everyday diagnoses remains unclear. Ashvini Keshavan et al update us (page 285) on how CSF biomarkers are used in their unit, ranging from how best to take the samples to their interpretation, including a discussion of the current limitations. Similarly, Mark Thaller et al run a specialist idiopathic intracranial hypertension (IIH) service. Given the condition mainly affects young women, they see many patients with IIH becoming pregnant; the team share their experience and provide practical advice on managing IIH before and during pregnancy (page 295). Giulia Navarro and Khalid Hamandi provide a further specialist unit update, discussing lessons from their video EEG telemetry unit (page 301). A general neurologist might understandably feel that something so highly specialised is not really relevant to their practice. However, patients and their relatives will often bring recordings of events made on their phones to clinic, and interpretation of these videos requires a similar approach and skills as those in the video EEG unit. Their videos available online are worth watching. Tom den Heijer describes his personal experience of sustaining a spinal cord stroke in 'Me and my neurological illness' that was most likely from fibrocartilaginous embolism (page 328). Sai Adithya Nagaratnam et al report a patient that they argue has the same condition (page 324). Fibrocartilaginous embolism arises from degenerative spinal disc material embolising to the spinal arteries. It can be diagnosed definitively pathologically but making the diagnosis in life is rather harder. The paper discusses its pathogenesis and constructs an approach to making the diagnosis. We have two reflective editorials from retired colleagues. Graham Flint, a neurosurgeon, asks 'Of what value is experience?' (page 262): experience helps in deciding when to intervene, and more significantly when not to intervene—to avoid unintended consequences. Ian Bone, a neurologist, describes 'The art of doing nothing' (page 264). In the past there were certainly more opportunities to do nothing in neurology and medicine in general, but we must still avoid being drawn to activity without benefit. He suggests we should reframe 'doing nothing' as a different way of 'doing something' with masterly inactivity. In addition to our usual case reports, Test Yourself and Carphology we have a Book Club report about an alternative approach to coping with selected unwanted consequences that people face in life. The prescriptions offered by 'Poetry Pharmacy' are, unsurprisingly poems, with choices matched to problems. This unusual proposition is well argued and entertaining, but no randomised poetic trials were reported. Was the Gloucester Book Club persuaded? Find out on page 338.


Background. The development of cytomegalovirus (CMV) infection after kidney transplant remains a significant cause of posttransplant morbidity, graft loss, and mortality. Despite appropriate antiviral therapy, recipients without previous CMV exposure can currently be allocated a kidney from a donor with previous CMV infection (D+R–) that carries the greatest risk of posttransplant CMV infection and associated complications. Preferential placement of CMV D– organs in negative recipients (R–) has been shown to reduce the risk of viral infection and associated complications. Methods. To assess the long-term survival and economic benefits of allocation policy reforms, a decision-analytic model was constructed to compare receipt of CMV D– with CMV D+ organ in CMV R– recipients using data from transplant registry, Medicare claims, and pharmaceutical costs. Results. For CMV R– patients, receipt of a CMV D– organ was associated with greater average survival (14.3 versus 12.6 y), superior quality-adjusted life years (12.6 versus 9.8), and lower costs ($529 512 versus $542 963). One-way sensitivity analysis demonstrated a survival advantage for patients waiting as long as 30 mo for a CMV D– kidney. Conclusions. Altering national allocation policy to preferentially offer CMV D– organs to CMV R– recipients could improve survival and lower costs after transplant if appropriately implemented.


Summary 1. Many floral displays are visually complex, transmitting multi-coloured patterns that are thought to direct pollinators to nectar rewards. These 'nectar guides' may be mutually beneficial, if they reduce pollinators' handling time, leading to an increased visitation rate and promoting pollen transfer. Yet, many details regarding how floral patterns influence foraging efficiency are unknown, as is the potential for pollinator learning to alter this relationship. 2. We compared the responses of bumblebee (Bombus impatiens Cresson) foragers to artificial flowers that either possessed or lacked star-like patterns. By presenting each bee with two different foraging scenarios (patterned flowers rewarding ⁄ plain flowers unrewarding, plain flowers rewarding ⁄ patterned flowers unrewarding) on different days, we were able to assess both short- and long-term effects of patterns on bee foraging behaviour. 3. Bees discovered rewards more quickly on patterned flowers and were less likely to miss the reward, regardless of whether corollas were circular or had petals. Nectar guides' effect on nectar discovery was immediate (innate) and persisted even after experience, although nectar discovery itself also had a learned component. We also found that bees departed patterned flowers sooner after feeding. Finally, when conditions changed such that flowers no longer provided a reward, bees visited the now-unrewarding flowers more persistently when they were patterned. 4. On the time-scale of a single foraging bout, our results provide some of the first data on how pollinators learn to forage efficiently using this common floral trait. Our bees' persistent response to patterned flowers even after rewards ceased suggests that, rather than being consistently mutually beneficial to plant and pollinator, nectar guide patterns can at times promote pollen transfer for the plant at the expense of a bee's foraging success.


This thesis examines a new approach to attribute-based access control with hidden policies and hidden credentials. In this setting, a resource owner has an access control policy that is a function of Boolean-valued attributes of the resource requester. Access to the resource should be granted if and only if the resource owner's policy is satisfied, but we wish to hide the access control policy from the resource requester and the requester's attributes from the resource owner.Previous solutions to this problem involved the use of cryptographic credentials held by the resource requester, but it is obvious that if no information is provided about the access control policy, then the resource requester must try to satisfy the policy using every available credential. An initial contribution of this thesis is the first published empirical evaluation of the state-of-the-art protocol of Frikken, Atallah, and Li for access control with hidden policies and hidden credentials, demonstrating that the computational cost of the required cryptographic operations is highly burdensome.A new system model is then proposed that includes the active involvement of online certification authorities (CAs). These are entities that can provide authoritative information about the attributes in a resource owner's access control policy. Allowing the resource owner to query these online CAs immediately removes the need for the resource requester to guess which credentials to use.If the resource owner was allowed to learn the values of a requester's attributes from online CAs, however, the requester's credentials would no longer be private. This thesis examines cryptographic solutions in which the CAs' replies do not directly reveal any attribute information to the resource owner, but can nevertheless be used in the enforcement of an access control policy. The techniques considered involve scrambled circuit evaluation, homomorphic encryption, and secure multiparty computation using arithmetic circuits and Shamir secret sharing. Empirical experiments demonstrate that the proposed protocols can provide an order-of-magnitude performance improvement over existing solutions.


Warm season turfgrasses can be grown successfully in the transition zone, but dormancy occurs to some extent during the winter. Overseeding with cool-season turfgrasses is necessary if winter dormancy of warm season turfgrasses is not tolerated. The increasing availability of zoysiagrass cultivars has enabled this genus to be considered suitable for low-maintenance golf courses, especially for golf tees and golf fairways. On the other hand, zoysiagrasses have the most rigid leaves of all turfgrass species, followed by bermudagrasses and by the other warm season turf species. Thus, to have a high mowing quality, mowers working constantly on zoysiagrasses require more sharpening than mowers working on other grasses. Rotary mowers are not suitable for mowing at low heights and often result in scalping, while reel mowers perform optimal mowing at a short height (below 2.5 cm) but require accurate management and frequent sharpening. Autonomous mowers have proven to produce a superior turf quality compared with traditional walk-behind rotary mowers, but no autonomous mower has ever been tested at a low mowing height on an overseeded warm season turfgrass. Because of this, the trial was carried out to simulate a golf tee overseeded with cool season turfgrasses, with low input fertilisation rates and with one of the most difficult turf species to mow; i.e. Zoysia matrella (L.) Merr. The trial was carried out in San Piero a Grado (Pisa, Italy) from October 2016 to October 2018. After a two-year period the best turf quality was achieved with Festuca rubra L. ssp. cultivars among the overseeded species, especially during fall. In many cases turf quality increased after manila grass green up since the combination of both cool season and warm season species gave a higher quality to the turfgrass, due to the finer leaf texture and higher shoot density of some cool season species. Moreover, recovery of manila grass ground cover was satisficing. In conclusion, a polystand of manila grass and Festuca rubra ssp. could be suitable for golf tees with low-input management.


The BICEP2 collaboration reports a B-mode polarization of the cosmic microwave background (CMB) radiation inconsistent with the null hypothesis at a significance of > 5 σ. This recent and potentially important result is being often interpreted as a signature of primordial gravitational waves from cosmic inflation. However, the arguments supporting such an interpretation are strictly based on standard cosmology and do not take into account possible new phenomena suggested by Planck data such as the existence of a privileged space direction. In particular, inflation is not needed in pre-Big Bang patterns, and the spinorial space-time (SST) introduced in our 1996-97 papers automatically generates a privileged space direction for each comoving observer. In the presence of this privileged space direction, the existence of CMB B-modes is a natural phenomenon and the signal claimed by BICEP2 would not correspond to any kind of inflationary scenario.


Introduction: Obesity is generally considered a chronic metabolic disease which is characterised by excessive accretion of adipose tissue. This pathology of fat accretion may lead to creation of pathological units, including gonarthrosis. The aim of the study was to evaluate the impact of body weight on functional performance in early stages of rehabilitation after knee replacement. Material and methods: The research material comprised 35 patients. The Group included 26 women and 9 men who suffer from advanced degenerative changes of knee joint and qualified for the knee replacement. The patients were assigned to one out of three Groups depending on body mass index. To assess the functional status the following tools were used: the VAS scale, 100-point Lysholm-Gillquist scale, the TUG test, and the measurement of the range of joint mobility. Results: Statistically significant results were achieved by first and second Group in joints mobility measurement. All the Groups revealed statistically meaningful differences in pain measurement with the use of VAS scale and 100-point Lysholm-Gillquist scale. Only third Group proved statistically meaningful outcomes while TUG test was used in the assessment. Conclusion: High body mass index does not have a negative impact on the re-establishment of functional ability after knee replacement. In the assessment of selected parameters (ROM, TUG), people who had BMI >35,00 kg/ m2 got better results than people who had lower BMI.


Although animals of many species kill and consume conspecifics, most such cases probably involve serendipitous encounters between the individuals concerned. In some taxa, however, cannibalism is an active process, with predatory individuals searching out and consuming specific types of conspecific prey items. Although anuran tadpoles often have been reported to consume conspecific eggs, this behaviour has been interpreted as a by-product of usual foraging behaviours rather than a result of targeted searching. Our field and laboratory studies in tropical Australia show that the tadpoles of invasive cane toads Bufo marinus are strongly attracted to chemical cues from conspecific eggs; the effective cues are released late in embryonic development, as the jelly coat breaks down. Tadpoles of native Australian frog species were attracted to the eggs of toads only rarely. If deployed as bait in traps, chemical cues from toad eggs could provide a way to selectively remove toad larvae from waterbodies.


The emerging area of (smart) Cyber Physical Systems (sCPS) triggers demand for new methods of design, development, and deployment of architecturally dynamic distributed systems. Current approaches (e.g. Component-Based Software Engineering and Agent-Based Development) become insufficient since they fail in addressing challenges specific to sCPS such as mobility, heterogeneous and unreliable deployment infrastructure, and architectural dynamicity. The strong dependence on the underlying communication infrastructure, often combining ad-hoc established links typical for wireless connectivity with more reliable connections of infrastructural networks, requires a novel method to optimize system deployment. In this paper we propose such a method based on the domain knowledge elicited from design level specification. As a proof of concept, we have provided an extension to the DEECo (Dependable Emergent Ensembles of Components) model and validated it on a scenario from the domain of Vehicular Area Networks.


Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women in their reproductive age.It is characterized by anovulation or oligo-ovulation and hyperandrogensim.Androgen excess is the central defect in polycystic ovary syndrome. It is a complex disorder affects general health in addition to oral health.This study aimed to assess the gingival health status among a group of women with polycystic ovary syndrome as well as to estimate the levels of salivaryfree testosterone in unstimulated saliva in relation to gingival health condition. Materials and methods: Sixty two women with an age range 20-25 years old and with a body mass index range18.5-24.9 (normal weight) were included in this study. They were divided into two groups; the study group which included thirty one women with polycystic ovary syndrome, those women. nattended Babylon Teaching Hospital/ Infertility Center and the control group which included thirty one women with regular menstrual cycles,without clinical or biochemical features of hyperandrogenism and ultrasound exclusion of polycystic ovary (without polycystic ovary syndrome). Collection of unstimulated salivary samples was carried out under standardrizedconditions, salivary free testosterone levels were estimated. Plaque index of Silness and Lӧe (1964) was used to assess dental plaque. While gingival index of Lӧe and Silness (1963) was used to assess gingival inflammation. Data analysis was conducted through the application of the (SPSS version 18). The analysis of data included: Mean, Standard deviation, t-test, Pearson Correlation (r), Receiver Operative Characteristics Curve (ROC curve). Results:Results showed that the mean value of plaque index was found to be higher in the control group (1.18±0.03) than that in the study group (1.00±0.08) with statistically highly significant difference (p<0.01).While the mean value of gingival indexwas higher among the study group (1.52±0.06)than that in the control group (1.31±0.05)with statistically highly significant difference (p<0.01).Salivary levels of free testosterone among women with polycystic ovary syndrome (44.12±1.37 pg/ml) were found to be higher than that of control (18.50±0.87) with statistically highly significant difference (p<0.01).The results in this study showed that the correlations between salivary free testosterone with the oral variables (plaque index, gingival index) were statistically not significant (P>0.05). In order to assess the specificity and sensitivity of the use of salivary free testosterone as a diagnostic tool, statistical analysis of Receiver Operative Characteristics Curve (ROC) was used and predictive Value Measurmentswere done in this study. The results showed that the area under the curve for salivary free testosterone test was (1.000) with highly significant p-value (p<0.01). The best optimal cut off point for salivary free testosterone was (30.86) with (100%) sensitivity and specificity, indicating a very good predictive capacity for using salivary free testosterone as a marker for the diagnosis of polycystic ovary syndrome. Conclusions : It was concluded that gingival inflammation was high among women with polycystic ovary syndrome. Furthermore, salivary levels of free testosterone were found to be high among women with polycystic ovary syndrome.


One of the most important aspects for all life on this planet is theact to keep their cellular processes in a state where they do notreach equilibrium. One part in the upholding of this imbalanced stateis the barrier between the cells and their surroundings, created bythe cell membrane. In addition to experiments, the investigation ofprocesses occuring in the cell membrane can be performed by usingmolecular dynamics simulations. Through this method we can obtain anatomistic description of the dynamics associated with events that arenot accessible to experimental setups. Molecular dynamics relies onthe integration of Newton's equations of motion in order to sample therelevant parts of phase-space for the system, and therefore it isdependent on a correct description of the interactions between all thesimulated particles. In this thesis I first present an improved methodfor the calculation of long-range interactions in molecular dynamicssimulations, followed by a study of cholesterol's impact on thepermeation of small solutes across a lipid bilayer.The first paper presents a previously derived modification to theparticle-mesh Ewald method, which makes it possible to apply thisto long-range Lennard-Jones interactions. Old implementations of themethod have been haunted by an extreme performance degradation andhere I propose a solution to this problem by applying a modifiedinteraction potential. I further show that the historical treatmentof long-range interactions in simulations of lipid bilayers hasnon-negligible effects on their structural properties.In the second paper, this modification is improved such that the smallerrors introduced by the modified interaction potential becomenegligible. Furthermore, I demonstrate that I have also improved theimplementation of the method so that it now only incurs a performanceloss of roughly 15% compared to conventional simulations using theGromacs simulation package.The third paper presents a simulation study of cholesterol's effect onthe permeation of six different solutes across a variety of lipidbilayers. I analyze the effect of different head groups, tail lengths,and tail saturation by performing simulations of the solutes in fourdifferent bilayers, with cholesterol contents between 0% and50%. Analysis of the simulations shows that the impact of the surfacearea per lipid on the partitioning of the solute could be lower thanpreviously thought. Furthermore, a model with a laterallyinhomogeneous permeability in cholesterol-containing membranes isproposed, which could explain the large differences betweenpermeabilities from experiments and calculated partition coefficientsin simulations.


Payroll is the sum of all financial records of salaries for an employee, wages, bonuses and deductions. In accounting, payroll refers to the amount paid to employees for services they provided during a certain period of time. Payroll plays a major role in a company for several reasons.


The present work is a corpus-based research on the plural forms of the second person pronoun you (2PL forms henceforth) which focuses on the similarities and differences among twenty varieties of English. The corpus (GloWbe) contains 1.9 billion words collected on the web in 2012. The 2PL forms I have analysed are the result of both morphological and analytic strategies of number marking: yous(e), yi(s/z), yus, you guys, you all and y(')all, you two, you three, you four, you ones and y(ou)'uns/yin(s/z), you lot and other you + NP-PL expressions. The aim of my research is provide an empirically informed description of the forms and functions of 2PL forms in contemporary English. This is done by combining the analysis of corpus data with the literature on 2PL forms as well as the relevant theories on language change. The results show that there are two main geographically-related trends in the use of 2PL forms: analytic strategies are preferred in the US, whereas morphological strategies are preferred in the European and Australian varieties of English. As far as the uses are concerned, 2PL forms were observed to perform other functions besides number-marking: they can work as possessive determiners and pronouns, singularreference emphatic markers, and attention-getting devices. The reanalysis of 2PL forms into markers of possession, the semantic bleaching evident in singular-reference 2PL forms, and the instances of phonological reduction observed in the forms y(')all and yin(s/z)) are seen as clues to on-going processes of grammaticalization. On the other hand, the significant involvement of 2PL forms in pragmatically charged contexts (mainly expressing emphasis and politeness) and the similarity of some attentiongetting 2PL forms to pragmatic markers are seen as clues to the pragmaticalization of 2PL forms. On a theoretical level, 2PL forms offer some insight on the processes of grammaticalization, pragmaticalization and intersubjectification. In particular, an alternative view of intersubjectification as a sub-process of pragmaticalization is proposed. Pragmaticalization, in turn, is seen as a distinct, independent process from grammaticalization. The linguistic evolution of 2PL forms is also described from the 4 perspective of constructionalization (Traugott and Trousdale 2014), which solves the issues related to the definition of the boundaries between grammaticalization, pragmaticalization and intersubjectification. Finally, the strong pragmatic character observed of singular-reference suffixed 2PL forms is used to support the theory of morphopragmatics (Dressler and Barbaresi 2015, 2017).


Summary Chotts Djerid and Fedjadj lie in the arid zone of southern Tunisia, and are chemically active, artesian environments which give rise not only to extensive emergent groundwater gypsum and salt deposits, but also to landforms of more complex architecture. In some geological situations belts of spring mounds up to 25 or 30 m high straddle former high-level late Pleistocene lake shorelines. Spring mounds are circular, gypsiferous or calcareous, volcano-like structures fed by point sources of artesian water rising from aquifers in the Continental Intercalaire and Complexe Terminal aquifer series. Similar mounds have been identified around playas in the USA, Australia, Egypt, Iraq and elsewhere. In some mounds a central well is occupied by a small pond with water conduits in the base, whilst others are dry and degraded. In these latter, water is only present at depth and wind erosion and redeposition are moulding the landforms. The morphology of spring mounds is determined by the balance between aquifer pressure head, output, chemical content, net evaporation, aeolian activity, and plant colonization. Their stratigraphy comprises alternations of crystalline materials, wind-blown gypsiferous sand, wash and splash deposits, and organic layers arranged in overlapping sequences which dip outwards from the water source. Such deposits offer a potentially sensitive index of environmental changes in the late Quaternary and Holocene.


This author analyses the international membership of the boards of directors of Russia's ten largest outbound investors. The data used in the study come from the companies' annual reports and official websites. The information is correct as of February 2017. It is concluded that foreign nationals hold 30 % of board seats in Russia's ten largest non-financial companies investing abroad. US, British, and German nationals comprise two-thirds of foreign nationals on the boards of directors. Among the 30 foreign holders of board seats, there is only one citizen of China. Women account for five percent of directors in Russia's ten largest investors overseas. The proportion of female directors in Russia's 50 largest corporations is similar. This suggests that internationalisation of Russian companies has not improved the chances for women to enter boards of directors.


The clinical picture and variants of the development hypoplasia of large bronchi in children are described on the basis of treatment of 12 children. Bronchoscopy and bronchography are the main methods of diagnosis of the disease. Twelve operations (4 of them plastic) are described. Specific features of the postoperative management of the patients are noted. Postoperative complications observed in two patients are analyzed.


Three groups of rainbow trout constituted by 100 individuals per group, with initial live weight of 50. 67±1. 954 g were kept in 5 m3 containers for 77 days. Two of them were fed on demand using mechanical equipments (Demand and Belt feeders). The feeding of the third group was done according to the traditional method, by hand. The effect of the way of feeding on condition factor values (K), specific growth rate (SGR), feed conversion ratio (FCR) and fin condition were studied. The k and SGR values have resulted higher in mechanical feeding than in hand feeding. Mechanical feeding improve also the feed conversion ratio. Lower values of pectoral and dorsal fin damage in both experimental groups compared with the control group, sampled a better situation of welfare when the feeding was provided on demand.


Muraglitazar (Pargluva), a dual α/γ peroxisome proliferator-activated receptor activator, has both glucose- and lipid-lowering effects in animal models and in patients with diabetes. The human major primary metabolic pathways of muraglitazar include acylglucuronidation, aliphatic/aryl hydroxylation, and O-demethylation. This study describes the identification of human cytochrome P450 (P450) and UDP-glucuronosyltransferase (UGT) enzymes involved in the in vitro metabolism of muraglitazar. [14C]Muraglitazar was metabolized by cDNA-expressed CYP2C8, 2C9, 2C19, 2D6, and 3A4, but to a very minimal extent by CYP1A2, 2A6, 2B6, 2C18, 2E1, and 3A5. Inhibition of the in vitro metabolism of muraglitazar in human liver microsomes, at a clinically efficacious concentration, by chemical inhibitors and monoclonal antibodies further supported involvement of CYP2C8, 2C9, 2C19, 2D6, and 3A4 in its oxidation. A combination of intrinsic clearance (Vmax/Km) and relative concentrations of each P450 enzyme in the human liver was used to predict the contribution of CYP2C8, 2C9, 2C19, 2D6, and 3A4 to the formation of each primary oxidative metabolite and to the overall oxidative metabolism of muraglitazar. Glucuronidation of [14C]muraglitazar was catalyzed by cDNA-expressed UGT1A1, 1A3, and 1A9, but not by UGT1A6, 1A8, 1A10, 2B4, 2B7, and 2B15. The Km values for muraglitazar glucuronidation by the three active UGT enzymes were similar (2–4 μM). In summary, muraglitazar was metabolized by multiple P450 and UGT enzymes to form multiple metabolites. This characteristic predicts a low potential for the alteration of the pharmacokinetic parameters of muraglitazar via polymorphic drug metabolism enzymes responsible for clearance of the compound or by coadministration of drugs that inhibit or induce relevant metabolic enzymes.


With the better understanding of the importance of the spleen as a primary organ of the human immune system, there has been an increased interest in performing the partial splenectomy for a number of indications such as nonparasitic cysts, benign tumors, staging of lymphomas, etc. Moreover, laparoscopic partial splenectomy has been gaining more interest as the recommended approach for benign splenic disorders to preserve the splenic function with very low recurrence rates. Meanwhile, many surgeons have attempted to reduce the number and size of the ports in laparoscopic surgery with the aim of inducing less parietal trauma and fewer scars. One of these efforts is single-port laparoscopic surgery, which is a rapidly evolving field all over the world. Here, we describe a feasible method of single-port laparoscopic partial splenectomy for treating a benign splenic cyst that was located in the upper medial aspect of the spleen.


Background: In recent years, the interest in relation to the identification of adaptive mechanisms through which people continue to improve their psychological well-being, despite the experience of chronic pain, has been observed. Acceptance is one of these positive psychological factors. We aimed to investigate the effect of Acceptance and Commitment Therapy for Children with Chronic Pain on externalizing symptoms in 7 to 12 year-old children. Methods: The present study was based on quasiexperimental model According to the criteria of chronic pain; a number of children with chronic pain were selected by available sampling method from specialty and subspecialty pediatric hospitals of Tehran. Then, 20 children who according to their parents were prepared to participate in this study and met the inclusion criteria, were selected and were placed in the experimental and control group. The Child Behavior Checklist was administered in both groups at the pre-test, post-test, first and second follow-up. Results: The results showed that the experimental group compared with the control group showed significant change in externalizing symptoms in multiple stages. These changes continued after the treatment, primary and secondary follow-up. Chi-square related to total score in experimental group was 26.21 (p=0.001) and chi-square related to total score in control group was18.55 (p=0.069). Conclusions: Generally, it can be said that this protocol can be used in clinical fields, especially in the area of improving the externalizing symptoms of children.


*These authors contributed equally to this work Purpose: To retrospectively analyze the efficacy and toxicity of epirubicin plus cyclophosphamide followed by docetaxel (EC-D) and epirubicin plus cyclophosphamide followed by paclitaxel (EC-P) efficacy as neoadjuvant chemotherapy regiments by pathological complete response (pCR) in this study. Methods: In total, 455 patients diagnosed with breast cancer who received NAC from January 2014 to January 2019 were enrolled. Of which, 109 patients received EC-D (E: 90, C: 600, D: 80, all in mg/m2) and 346 were treated with EC-P (E: 90, C: 600, D: 175, all in mg/m2). Efficacy of NAC regimens was evaluated by pCR, and the toxicity was studied. Chi-squared test was used at p=0.05. Results: In EC-D, 11 patients received ypT0/isN0, and 6 of them got ypT0N0. Analogously, 67 patients receiving received EC-P obtained ypT0/isN0, and 43 people of them acquired ypT0N0. The rate of pCR in EC-P was higher than EC-D. Patients with ER (-), PR (-), Her-2 (+) and high Ki-67 index were easier to were more likely to acquire pCR. Two pCRs were described, the pCR of NAC differed according to the definition. In terms of side effects, there was no significant difference in platelet and urea, but the decrease of hemoglobin and creatinine levels after EC-P treatment was more significant than that after EC-D treatment. Conclusion: The efficacy of EC-P is better than EC-D if pCR is to be determined as a surrogate end-point for prognosis. The patients with anemia or renal insufficiency who need to receive NAC should choose EC-D.


BACKGROUND Graduate midwives require substantial support during their first year of midwifery practice to develop their confidence. Midwives are autonomous professionals who require a high-level skill of clinical decision-making. Social supports protect individuals from the stress of a critical event and consist of four components (appraisal, tangible, belonging, self-esteem). The new midwives' experience of social supports during the first year of midwifery practice plays a crucial role to increase new midwives' levels of confidence during this transition period. AIM This qualitative systematic review aims to synthesis the new graduate midwives' experiences of social supports during the transition period of midwifery practice. The objectives of this systematic review are to: describe the transition period experiences of new graduate midwives and examine what constitute social supports during transition period. METHOD This systematic review followed the method for qualitative synthesis from Joanna Briggs Institute. Search of published studies was undertaken of four databases without time restriction. Studies that met inclusion criteria were then appraised using JBI Qualitative Assessment and Review Instrument. RESULT Eight published studies were included in this systematic review. From these eight studies, 52 findings were extracted, eight categories were formed and three synthesized findings were generated. The heading of three synthesized findings of new midwives' transition period experience are: 'personalised support programs', 'relationship with others and self', and 'previous experience of learning and practice and gap between expectation and reality'. Components of social support such as appraisal and tangible support appeared in personalized support programs and relationship with others and self. While belonging and self esteem support emerged in relationship with others and self and previous experience of learning and practice and gap between expectation and reality. CONCLUSION This review identifies the experiences of new graduate midwives during transition period of midwifery practice. Social support components are integrated in the three elements of new midwives' transition period experience. Social support during new midwives' transition period underpins their confidence, which in turn improves their performance to carry midwifery care.


This research focusses on the realization of adaptive architecture with the use of advanced material technology. Current material research has shown significant advances with the development of "smart" materials. Smart materials are "capable of automatically and inherently sensing or detecting changes in their environment and responding to those changes with some kind of actuation or action". These materials have intrinsic characteristics that enable the detection of an external stimulus and initiate an appropriate action, by adapting the material properties. Thus, smart materials have both sensory and actuation characteristics. By introducing smart materials in the building system immediate adaptive environments can be realized. The purpose of this research is to study the application and performance of smart materials for the realization of a shape morphing adaptive building component (ABC). The ABC should be able to realize a reversible hinge-like deformation. This means that a flat strip of materials should be able to bend into a 90° angle. The deformation should be fixated without constant energy input and recover into the initial flat configuration when desired. This research has started with an overview of the current state of adaptive architecture. Additionally, the application of smart material systems in architecture has been analysed. Design scenarios illustrate the application field of the ABC in the building system. When the building system can sense, process and act a new functional relationship is established between the building and its users. Immediate adaptive environments will change the user perspective on the built environment. Adaptive architecture will lead to a whole new paradigm of the building design and use. By the use of an internet inquiry and interviews, an insight is created into the participant's receptiveness on immediate adaptive environments. Subsequently, the realization of a shape morphing building component with the use of smart materials is analysed. Shape adaptation in architecture is an interesting field of research in terms of functionality and realization. The performance is demonstrated by the fabrication of a full working prototype. After a smart material analysis, a composite system of shape memory alloys (SMAs) embedded in a shape memory polymer (SMP) matrix is presented that met the design requirements. The performance of this smart composite (SC) is analysed thoroughly. Both the SMA and the SMP are thermo-responsive materials and are activated by resistive heating. In general, it could be stated that the desired performance of the SC is realistic with the current materials. The performance of the SC prototype has shown a reversible shape deformation with the use of smart material systems. The significant technical advantage of this system is obtained by the fixation of the deformation without constant energy input. However, optimization in terms of cycling, performance and manufacturing is required in order to realize large–scale application in building systems. Accurate control of the individual smart materials systems is an important aspect in optimization of the SC performance. The thermoelectric activation of both the SMA and SMP were simulated by finite element modelling. The simulation software ANSYS is used here in order to create the model. This numerical model is validated by thermal experimentation with the use of a thermal imager. The validation experiments indicated that the finite element model is in good agreement with the physical material performance. Both the thermal activation of the SMAs as the integrated heating wires gave near identical thermal outputs. The finite element analysis is used for the determination of the most profound operating settings of both the SMAs as the heating wires. The numerical model can be adjusted to different dimensions and can determine the accurate thermal control of the smart composite. This research can be considered a first step into the new performance of architecture, whereby shape-morphing environments are realized by the use of smart material technology. The promising results of the fabrication and performance of the SC, show a realistic future for shape morphing building components based on intrinsic material characteristics. With the fabrication of the SC, the translation from virtual into real-time adaptive building components has been envisioned.


This guide is designed to assist LED practitioners – staff from international organizations, international development agencies and local authorities– in identifying and addressing the sometimes different needs and priorities of women and men, facilitating their full participation at every stage of the LED process, and contributing to gender equality objectives and outcomes. Using this guide will enable practitioners to: understand why gender equality should be pursued at the local level; be aware of the barriers to women's participation that may be encountered; and identify and implement strategies for addressing gender concerns throughout the LED process. Since gender mainstreaming should be context-specific, the recommendations made must be considered as indicative guidelines rather than recipes for action. Under each section, reference is made to tools, further readings and checklists that can be used in project design, implementation, and monitoring and evaluation.


Breast cancer is the most prevalent cancer in women worldwide and is the most common cancer diagnosis made during pregnancy or in the postpartum period. When breast cancer is diagnosed either during pregnancy or in the first-year postpartum, it is referred to as pregnancy-associated breast cancer. The aim of this review is to assess existing literature regarding the recommendations and outcomes of participating in exercise for people with pregnancy-associated breast cancer. The occurrence of pregnancy-associated breast cancer is increasing as a growing number of women delay first pregnancies. Women undergoing treatment for pregnancy-associated breast cancer are dealing with both cancer and its treatment as well as a pregnancy or postpartum period, and often encounter symptoms associated with cancer diagnosis and treatment, such as nausea, pain and fatigue while simultaneously navigating a pregnancy or early motherhood. These experiences can be barriers to participating in exercise, despite exercise being associated with numerous benefits for both pregnancy health and breast cancer outcomes. Numerous studies report the benefits of exercising during breast cancer treatment in ameliorating associated symptoms, and some studies report that engaging in exercise can lead to healthier and lower risk pregnancies. However, there is a lack of consensus around appropriate exercise programmes for this specific population. Given the associated benefits of participating in exercise for both breast cancer patients and pregnant/postpartum women as separate groups, research into exercise medicine designed specifically for the pregnancy-associated breast cancer population is needed.


We have analyzed 1361 death certificates, during the year of 1982 in Uberlandia (Brazil), all deaths of residents and not deathbirths. In 47% the deaths were assisted by a physician and the cause of death proved. The first basic cause of death found was cardiovascular diseases (23.3%). The second, infectious diseases particularly Chagas' disease (14.9%) and the third traumatic lesions and poisonings (14.4%). Cerebrovascular diseases were the seventh basic cause of death (6.5%) but the third most related disease at the death certificates (12.7%). It is important to stress that the mortality index change considerably if we consider the disease as a basic cause of death or in more than one position in the death certificate. For instance in Uberlandia the index for CVD was 30 and 63/100.000 inab/year, respectively. The carriers of arterial hypertension presented CVD related at death certificate 10 times more than in the not carriers of hypertension.


This paper presents an algorithm for the selection of corrective control actions for bus voltage and generator reactive power in a power system. A genetic algorithm (GA) using linear approximation of load flow equations and a heuristic selection of participating controls were combined in a search method for the minimum number of control actions. The method was successfully applied on a 220-bus model for several cases of disturbed load flow, and calculation time was proven to be small enough to allow real-time application of the algorithm. The GA was compared with a integer programming-based solution method and showed a considerably reduced calculation time.


This paper mainly discusses the current situation of the internationalization development the issues and challenges faced of enterprise standards in China in recent years, and the countermeasures and suggestions to be taken in the future. The research methods of qualitative analysis and case studies are mainly adopted. Both primary and secondary information resources are collected for an analysis and recognition of the progress of internationalization of Chinese enterprise standards. The key issues in the internationalization process of Chinese enterprise standards are put forward through analysis of the lessons learned such as lack of consistency in technology standards and real needs in the process of internationalization of Chinese enterprise standards in the last two decades, especially in the practice of participating in foreign infrastructure construction. Under China's "One Belt and One Road (B&R) Initiative", the high quality Chinese enterprise standards and internationalization are the prerequisite for the realization of international cooperation in science and technology. The novelty of this paper is mainly reflected in the countermeasures and suggestions how to enhance the internationalization level of Chinese enterprise standards in accordance with the initiatives of the "B&R" construction and the countries concerned actual needs. These include to further improve the technology level and quality of enterprise standards, improve the applicability of Chinese enterprise standards, strengthen international exchanges and cooperation in the field of standardization, establish and improve standard information resource sharing in big data environment, enhance the competitiveness of enterprises, and realize mutual benefit and win-win situation in "B&R" international cooperation.


AIMS
Due to a large number of identified hub-genes, encoding key molecular regulators, which involve in signal transduction and metabolic pathways in cancers, it is relevant to systemize and update these findings.

BACKGROUND
Colorectal cancer (CRC) is the third leading cause of cancer death in the world with high metastatic potential. Elucidating the pathogenic mechanisms and selection of novel biomarkers in CRC is of great clinical significance.

OBJECTIVE
This analytical review aims at systematization of bioinformatics and experimental identification of hub-genes, associated with CRC, for a more consolidated understanding of common features in networks and pathways in CRC progression as well as hub-genes selection.

RESULTS
In total, 301 hub-genes were derived from 40 articles. The "core" consisted of 28 hub-genes (CCNB1, LPAR1, BGN, CXCL3, COL1A2, UBE2C, NMU, COL1A1, CXCL2, CXCL11, CDK1, TOP2A, AURKA, SST, CXCL5, MMP3, CCND1, TIMP1, CXCL8, CXCL1, CXCL12, MYC, CCNA2, GCG, GUCA2A, PAICS, PYY and THBS2) mentioned in not less than three articles and having clinical significance in cancer-associated pathways. Of them, there were two discrete clusters enriched in chemokine signaling and cell cycle regulation genes. High expression levels of BGN and TIMP1 and low expression levels of CCNB1, CXCL3, CXCL2, CXCL2 and PAICS were associated with unfavorable overall survival of patients with CRC. Differently expressed genes such as LPAR1, SST, CXCL12, GUCA2A, and PYY were shown as down regulated, whereas BGN, CXCL3, UBE2C, NMU, CXCL11, CDK1, TOP2A, AURKA, MMP3, CCND1, CXCL1, MYC, CCNA2, PAICS were up regulated genes in CRC. It was also found that MMP3, THBS2, TIMP1 and CXCL12 genes were associated with metastatic CRC. Network analysis in ONCO.IO showed that upstream master regulators RELA, STAT3, SOX2, FOXM1, SMAD3 and NF-kB were connected with "core" hub-genes.

CONCLUSION
Results obtained are of useful fundamental information on revealing mechanism of pathogenicity, cellular targets selection for optimization of therapeutic interventions as well as transcriptomics prognostic and predictive biomarkers development.


How entrepreneurial orientation (EO) as a strategy manifests into entrepreneurial behaviors like innovation, is an important research topic but not well understood. There is a gap in the examination of EO and entrepreneurial behavioral outcomes. Since mediators exist (see Rauch, Wiklund, Lumpkin, & Frese, 2009; Wales, 2016; Wales, Patel, Parida, & Kreiser, 2013) additional research is needed to uncover these potential relationships. Research suggests that management controls systems (MCS) may serve as a mediator between strategy and innovation outcomes. There is, however, conflicting evidence regarding the impact and use of management control systems (MCS) in the small firm context. As such, we examine the relationship between an individual-level measure of EO (IEO) and innovation level and explore the mediating role of financial and nonfinancial MCS on that relationship. Results suggest that nonfinancial MCS partially mediate the relationship between IEO and innovation, while financial MCS do not.


OBJECTIVE
Dysfunction of high-density lipoprotein (HDL) may contribute to coronary heart disease (CHD) risk. We determined whether aggregation to lipoprotein (Lp)(a) of apolipoprotein (apo) A-I underlies HDL dysfunction conferring incident CHD risk.

METHODS
A representative sample of 1509 middle-aged Turkish adults was studied at 4.9-years' follow-up yielding 198 incident CHD cases. Statistical analysis was performed using multiple linear regression and Cox proportional regression analyses.

RESULTS
In women, not age or apoA-I, rather complement C3, apoE levels and statin use were linearly related to log-Lp(a). Individuals in the low Lp(a) tertile (<6.4 mg/dL) displayed high mean triglyceride and apoE values, and geometric mean Lp(a) values increased moderately in subjects having low and mid tertiles of apoE or triglycerides, only to be lower in the high tertiles (p≤0.002). These two findings indicated the unexpected fall in Lp(a) under circumstances of high apo E (>4.5 mg/dL) and/or triglycerides (>2.0 mmol/L). Levels actually represent aggregation of Lp(a) to apoA-I in an immune complex, rendering apoA-I atherogenic. Lp(a) did not, but apoA-I did significantly predict incident CHD (HR 1.21 [95%CI 1.07; 1.37]) in Cox regression analyses after adjustment for conventional risk factors and statin use. This adverse action of apoA-I was independent of prevalent metabolic syndrome (MetS), existed in individuals in whom ATPIII-defined MetS was not identified, and was similar in magnitude to that of conventional risk factors.

CONCLUSION
Beyond being atherogenic, Lp(a) may aggregate in a pro-inflammatory milieu to apoA-I, rendering apoA-I atherogenic. This process is independent of ATPIII-defined MetS and exhibits risk magnitude similar to that of conventional risk factors.


High product quality, service reliability, and management of operations are key factors in business growth and sustainability. Analyzing "The Starbucks Experience" is a pedagogical approach to reinforcing the concepts of control and management of quality, service reliability, and efficient operations in action. The objective of this paper is to show how providing high-quality, reliable products and service at Starbucks have influenced its market share, productivity, and profitability. In turn, Starbucks has improved on these business measures by excelling in operations management. The approach taken was to research the early days at Starbucks to gain insight on what made Starbucks so successful and then to use observational research to assess the customer experience at a particular Starbucks store in a city in the state of Michigan, USA. Sitting in this Starbucks store in the city's little downtown and observing its operations and customers contact offered the opportunity to observe customers waiting in line, the baristas serving the customers, examining the store's layout, and listening to conversations that revealed what customers like and dislike about "The Starbucks Experience." Recommendations are made to improve operations. These areas fall under operations management for a company that sells a product and provides a service. There are three reasons customers choose Starbucks: the coffee, the people serving the coffee, and the experience in the stores. By excelling in these three areas and improving operations management, Starbucks can regain its market share, and improve productivity and profitability.


This empirical paper adds to competition and industrial organization literature by exploring the interplay between industry structure and competitiveness on local, rather than nation-wide, markets. We use micro-level statistical data for banks in two Russian regions (Bashkortostan and Tatarstan) to estimate Herfindahl-Hirschman index, Lerner index, and Panzar-Rosse model. We estimate Panzar-Rosse model in two ways: via the widely used price-equation that accounts for scale effects and then via a revenue-equation that disregards scale effects as suggested by Bikker et al. (2009). We find both regional markets to be ruled by monopolistic competition, although estimation by revenue-equation does not reject monopoly hypothesis for Tatarstan. Existence of sizeable locally-owned and operated institutions does not necessarily lead to higher competitiveness of the given regional market, and the results from non-structural methods of estimation suggest that bank competition in Bashkortostan is stronger than in Tatarstan. Going further away from aggregated analysis we compute Lerner indices in two product segments of Tatarstan – retail and corporate loans – and find that retail segment is significantly more competitive. Local banks exert more market power in corporate loans, while federal branches – in retail loans.


Climate change is perhaps the most serious environmental threat to whom African agriculture is confronted today, essentially because of its impact on preand post-harvest agricultural productivity. Available literature shows that most of the recent studies on climate change and agriculture were mainly focused on pre-harvest, with little or no emphasis on post-harvest issues. This study aims to provide empirical information on the effect of climate change on cassava processing and on the cost-effectiveness of indigenous adaptation practices relative thereto. The study was conducted in two randomly selected states of southeast Nigeria and in four randomly selected agricultural zones, two from each state. The data were collected using a well-structured questionnaire administered to 320 randomly selected cassava processors. The result of the analysis shows that the respondents were predominantly women who, in addition to cassava processing, also grow cassava. Virtually all of them were, not only aware of climate change, but also aware that it will have effects on cassava post-harvest operations. The respondents suggest that as a result of climate change, the length of time cassava tubers can stay in the soil without spoiling has been decreasing while the water content of cassava tubers has been increasing. In addition, the storage quality of all the products has been deteriorating, just as the growth of spoilage moulds in the products during storage has been increasing. Moreover, the fermentation period for akpu and alibo has been increasing while there has been a general decline in the quantity of product yield after processing for all the products. Some of the adaptation measures used by the processors include increased use of water, palm oil, hired labour and wood fuel, increased harvesting of cassava earlier than usual, processing of more adaptive varieties of cassava, shifts in the timing of processing as the weather also shifts and increased fermentation in the open spaces. There were also some relatively new adaptation practices such as the use of detergents, nails, beans and bitter leaf to aid fermentation, especially for the production of akpu and alibo. In terms of profitability, the four adaptation practices with high profitability indices were, in order of decreasing importance, increased use of sundrying, water, hired labor and palm oil. The study therefore recommends that breeding of improved varieties of cassava should begin to target those that are tolerant to excessive and extreme fluctuations of rainfall, heat and flood. In addition, the adaptation practices with high profitability indices should be vigorously disseminated. Also, further studies, especially on the chemistry of the observed relatively new adaptation practices should be explored.


In the United States alone, 800,000 children within the child welfare system will be diagnosed each year with severe attachment disorder because of serious abuse and neglect Most available treatment or methods of therapy involve psychiatric nurses working to build trust and the formation of healthy attachments and relationships with children with Reactive Attachment Disorder of Childhood (RAD). The purpose of this thesis was to explore relationship building between the psychiatric nurse and the child with RAD from the perspective of the nurse. Participants were four psychiatric nurses currently working in the field who had at least two years of adolescent psychiatric treatment experience. The participants were all asked about their experience forming relationships with children diagnosed with Reactive Attachment Disorder. Field notes and theoretical memos were written throughout the study. A theoretical model was developed to describe the basic social processes. Classic grounded theory analysis was used to analyze the data and discover categories. Transcripts were read, coded, and categories emerged. The core category identified from this study was "Developing a Relationship." The supporting categories were "Recognizing Personal Weaknesses," the nurses ability to objectively work with a patient while taking care of themselves, "Knowing their Behaviors," recognizing the characteristics and expected behaviors of children with RAD, and finally "Initiating therapy," when the relationship is formed successfully. A theoretical model was developed which describes the cycle of the therapeutic nursing relationship. This model can be used by nurses to gain an understanding of the phases of the therapeutic relationship between the nurse and patient, and can be modified to fit clinical practice. Running head: PHILLIPS Nursing Relationships with RAD 5